Diffuse esophageal spasm diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]

Diffuse esophageal spasm Microchapters
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Diagnostic study of choice
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Overview.

The diagnostic study of choice for DES is manometry.

Diagnostic Study of Choice for DES

Gold standard/Study of choice:

• Conventional manometry testing is the gold standard test for the diagnosis of DES.

Sequence of Diagnostic Studies

The upper GI endoscopy, Barium swallow, esophageal PH monitoring and Manometry should be performed after an ECG and cardiac work up when:

• The patient presented with chest pain and/or dysphagia as the first step of diagnosis.

Diagnostic Criteria

• DES is diagnosed based on The Chicago Classification v.3.0
• On conventional manometry, > or equal to 20% or more of simultaneous contractions (amplitude > 30 mm Hg) defines DES.
• On high resolution manometry (HRM), greater or equal to 20% premature contractions (with distal latency < 4.5 seconds) defines DES.
• Manometric presentation is intermittent and may not be present on each swallow during testing.

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